Interactive Transcript
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Here we have a series of radiographs
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and MR in an unfortunate boy who,
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at the age of two years, had a very bad
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injury to his epiphyseal cartilage.
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Here are the initial
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radiographs that we saw.
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Actually, the injury happened before this,
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but these are the earliest films that we have.
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At this point, the child is two years of age.
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This is the normal frontal
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projection, uh, on the left side.
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And this is the abnormal
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projection on the right side.
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As you can notice, the epiphyseal
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cartilage here has just disappeared.
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You can sort of make a hint of
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something soft tissue right over here.
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And I suspect that this is what is
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remaining of cartilage of the epiphysis.
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If the border of it is sort of inferiorly
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located, uh, there's a gap between the bony
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structure here and the cartilaginous margin
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over here, but that's just my suspicion.
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I can't be sure looking
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at this plain radiograph.
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For a normal comparison, that's what a normal
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epiphysis of a two-year-old should look like.
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It should be nice and symmetric.
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So definitely, we're missing a
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chunk of the lateral epiphysis.
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Now we're getting another radiograph from
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when the child is three years of age.
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I'm going to bring up the normal left
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side and the abnormal right side.
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You can see now the disordered formation
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of these ossification centers.
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Because the cartilage has been injured,
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there's been compromise of the vascular
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system, disorganization of the vascular system.
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Remember from the earlier vignettes,
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we know that vessels are needed to
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cause cartilage to form into bone.
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So this tells me vessels are still there, but
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they're not getting there in the right amount or
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in the right distribution, uh, or what have you.
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So we have these sort of rests
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of cartilage here and here.
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And there may be loose bodies, we don't know.
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So this is one year later.
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Again, the normal developing
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epiphysis on the contralateral side is
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beautifully shown on this radiograph.
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Uh, you're welcome to look
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at the lateral views also.
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Um, you have access to it
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through your PAC system.
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But I'm just showing you the salient
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images for the sake of timing.
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Now, I'm going to show you what happened to
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this child all the way up to 12 years of age.
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First, I want to bring up a leg length study.
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I'm going to bring this up as a one-on-one.
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And just an overview.
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Notice that there is a bowing deformity
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of that midshaft of that right femur.
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The right femur's overall length also appears
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to be a little shorter than the left femur.
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Notice the lateral condyle has actually
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formed pretty well, but it's definitely
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shorter or smaller than the medial condyle.
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So all of that results in an overall
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decreased length of the right lower extremity.
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Remember we talked about injuries to the
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cartilage and physis eventually will manifest
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later as leg length discrepancy or deformities
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in alignments such as varus or valgus problems.
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Now, finally, I want to show you what
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the MR looks like at 12 years of age.
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I think for that, the best sequence
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that I can show you, there are several
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great sequences, but I really like our
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sagittal depths, which is over here.
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I'm going to zoom up for that just a little bit.
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And I'm going to bring up a coronal.
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This is our space.
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This is a 3D acquired isovolumetric
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proton density sequence.
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I'm going to zoom up on that also a little bit.
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So let's look at the sagittal views.
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Here are the areas of cartilage, uh,
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that are forming rests of cartilage.
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I think this, these little pieces of bone
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that are formed in the cartilage are actually
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contained within a bigger cartilaginous on log
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that's not separate from your main epiphysis.
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Thanks.
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Because of the devastating injury, they have
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formed their own ossification centers and never
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quite fused with the main ossification center.
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You can also see lines of fracture
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over here where you have injury.
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There's, there's injury to the physis.
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You have physial bar.
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You know, where the growth plate
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was not injured, we still have
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a nice trilaminar appearance.
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The coronal view here shows you that
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there are actually some loose bodies in
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the joint, which is best depicted here.
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And this image right over here.
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So, and I think you can also appreciate
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the fact that this condyle, the
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medial condyle, has a different shape
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and size than the lateral condyle.
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Because there is a synergy between the size
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of the meniscus and the size of the condyles,
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the ipsilateral meniscus is also enlarged
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and bigger than the contralateral side.
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Similar, if you remember, to
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what we saw on Blount's disease.
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When there is an injury to the The epiphysis,
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it manifests as changes in your meniscus also.
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